Provider Demographics
NPI:1275848582
Name:WHITNEY, SHAUN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 W KATHLEEN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7365
Mailing Address - Country:US
Mailing Address - Phone:208-664-7300
Mailing Address - Fax:
Practice Address - Street 1:1322 W KATHLEEN AVE STE 2
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7365
Practice Address - Country:US
Practice Address - Phone:208-664-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4420EN1223E0200X
IDD4420PE1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223E0200XDental ProvidersDentistEndodontics